Digital rectal examination, serum prostate specific antigen, and prostatic ultrasound: how effective is this diagnostic triad?

Ninety-nine of 105 consecutive men who underwent transrectal prostatic ultrasound (TRUS) at Highland Park Hospital had the results correlated with digital rectal examination (DRE), serum prostate specific antigen (PSA), and biopsy results. Ninety-six cases had evaluable ultrasound studies. Thirty-two of the 99 who underwent biopsy had primary carcinoma of the prostate. Prostate volume, predicted PSA, a ratio of observed/predicted PSA, and Gleason score were examined. There was no correlation between age and prostate volume, volume and the presence of carcinoma, or PSA and Gleason score. Thirty-one point six percent of the abnormal DREs, 36.6% of the abnormal TRUSs, and 40.6% of the elevated PSAs occurred in men with prostatic carcinoma (PCa). If PSA was normal (less than or equal to 4.0 ng/ml) and either DRE or TRUS was abnormal, then the risk of carcinoma was 2.9%. If PSA was elevated, regardless of the other two tests, the risk of finding PCa was at least 38%. If all three tests were abnormal, the risk of carcinoma was 38% in our series and 68% in a meta-analysis. Many men with PSA values between 4 and 10 ng/ml have benign biopsies. However, close future follow-up with consideration of repeat biopsy should be strongly considered.

Noninvasive localization of urinary tract infection: clinical investigations and experience.

Previously we evaluated new methods to localize the source of bacteriuria in monkeys with experimental urinary tract infection. A high level of diagnostic accuracy was obtained with studies of antibody coating of urinary bacteria by immunofluorescence, 131iodine hippuran quantitative scintillation camera studies with the patient in the hydropenic state and 67gallium citrate scintiphotos. We identified unique patterns that differentiated cystitis, ureteritis, pyelonephritis and renal or perinephric abscess. Herein we review our clinical experience with these combined techniques in 40 patients and correlate the degree of accuracy of these studies with that of standard radiographic examinations. In 20 patients diagnostic studies also were compared to the findings of split ureteral urine cultures or bacteriologic culture of renal tissue obtained from surgical specimens or autopsy. The use of the quantitative scintillation camera studies done with the patient in a state of controlled hydropenia increased clearly the level of diagnostic sensitivity in demonstrating the source of a urinary tract infection compared to urine culture and excretory urography alone. In patients with an abnormal 131iodine hippuran study the performance of 67gallium renal imaging on the same day usually provided information that allowed specific localization of the source and extent of an infection. Both studies must be performed with a high degree of resolution over the renal areas and then must be interpreted carefully to ensure accuracy. Study of antibody coating of urinary bacteria was helpful in suggesting the presence or absence of upper urinary tract disease but was less sensitive and accurate than the combined radionuclide studies.

Experimental pyelonephritis. V. Functional characteristics of pyelonephritis.

Changes in renal and ureteral function were studied in monkeys with experimental pyelonephritis, and correlated with the findings of 131I Hippuran scintiphotos. During the acute phase, delayed excretion of radionuclide was found to be a combined result of prolonged intrarenal as well as ureteral transit times. During the chronic phase, scintiphoto studies revealed decreased renal uptake of radionuclide suggesting decreased renal blood flow. Subsequent individual renal function studies confirmed the decrease in renal function and provided data that strongly support the "intact nephron hypothesis" in chronic pyelonephritis.

Multiple endocrine adenomatosis: in support of the common origin theories.

Herein we give clinical support to the theory of a common origin of multiple endocrine adenomatosis. Accurate clinical evaluation of a patient suspected to have endocrine neoplasia requires the search for a much wider range of potential endocrine tumors. Such an approach is now made possible by the radioimmunoassay. Chromosome patterns and histocompatibility antigens are reviewed in a family with the disease.

Non-invasive localization of urinary tract infection.

New methods to localize the source of bacteriuria were evaluated in monkeys with experimental urinary tract infection. A high level of diagnostic accuracy was obtained with the combined study of antibody-coated urinary bacteria by immunofluorescence, 131I hippuran scintiphotos in the hydropenic state and 67gallium citrate scintiphotos. Unique patterns were found, which differentiate cystitis, ureteritis, pyelonephritis and renal or perinephric abscesses.

Displacement of left kidney suggesting adrenal tumor.

Several infants with a left suprarenal "cold spot" shown on technetium scintiphotos were also found to have inferior displacement of the left kidney on the urogram. Surgical exploration was considered on the basis of possible adrenal tumor; however, the highly suspicious "lesion" disappeared after gastric deflation, and it was recreated after gastric distention. Review of infant urograms has shown that gastric distention is a common cause of a "normal" low-lying left kidney, in clear distinction to the adult in whom a displaced left kidney frequently shows a pathologic condition.

Duodenal hematoma. Critical analysis of recent treatment technics.

Analysis of the fifty-six cases of duodenal hematoma reported since 1966 shows a significant rise in incidence, with uncertainty regarding the most appropriate approaches to therapy. The diagnosis can generally be made by recognizing the "coil spring" sign on upper gastrointestinal series. Thirty-four per cent of the patients reviewed were treated successfully with conservative management. Sixty-two per cent were treated surgically. Fifty-one per cent of the surgical patients were treated by simple evacuation of the hematoma, and 12 per cent of these required reoperation for recurrent obstruction. Forty per cent of the surgical patients were treated by evacuation and gastrojejunostomy, and 21 per cent of these required reoperation for marginal ulceration. A previously unreported case is presented and a new surgical approach utilizing gastroduodenostomy is described, which is believed to offer potentially less risk of subsequent marginal ulceration or recurrent duodenal obstruction.